Protection of Life During Pregnancy Bill 2013: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

Deputy Micheál Martin

I welcome the opportunity to speak on the Protection of Life During Pregnancy Bill. I also welcome the generally restrained and constructive tone in which the debate has been conducted so far in this House. I have said from the start that Fianna Fáil will not treat this issue as a political football. It is a complex, sensitive and personal issue which has been actively debated for over 30 years. We should have no tolerance for personal or political grandstanding on the issue.

There is no more fundamental issue for a society than its attitude to life. It is an ethical issue which goes to the very heart of our values. Ireland is far from unique in having an ongoing public debate about issues to do with life. It is very positive and one which I hope remains. I would much rather live in a society which has lengthy and sometimes emotional debates about the issue of life than in one which ignores it completely. This is not to say every contribution to the public debate has been constructive. There is an extreme fringe which recognises no boundaries of basic decency in promoting its view. Many of us in this House have had personal experience of this fringe’s behaviour. It must, however, not be allowed to distract us or drown out the much more significant campaigns of other groups which are also against this legislation but which promote their views in a fair and democratic way. They have a right to be heard without being linked with the actions of a tiny minority. I have no doubt that a strong majority is against us in moving towards any liberal abortion regime. These views are not reactionary and not the result of blindly doing what religious or other leaders instruct. We should all reject any attempt to caricature or dismiss such sincerely held views. They are based on a profound respect for all aspects of humanity.

During my time as a public representative, I have what I believe is an absolutely clear record in supporting measures which respect the protection of human life. For example, I am proud to have voted for and helped to enact legislative and constitutional change which first abolished and then banned the death penalty. Regarding life during pregnancy, I have been a pro-life legislator. I understand this label annoys some, but it is a term which is widely understood. I do not use it to set it in contrast against other opinions. In approaching this legislation my position remains as it has been in the past. We have a constitutional and moral duty to protect human life in pregnancy. My vote will, I believe, be fully consistent with this, although it will displease some whose views I respect. I will be voting for the legislation because I believe it is tightly drawn and respects the provisions of Article 40.3.3o of the Constitution. It is as restrictive as it is possible to be within the terms of the law as laid down by the Supreme Court and the decisions of the people as reflected in two referendums. I do not believe it is possible to find completely uniform professional opinion on any proposal in this area. However, the Bill fairly represents what appears to be the predominant opinion about how we should proceed.

It is not true that this is an issue which has been ignored for 21 years. It is not the first time any legislation has been produced concerning abortion. The 2002 proposal that was defeated by the people followed extensive public consultation, expert hearings and an all-party committee report. With the major exception of the suicide provision, much of that legislation was similar to what is before the House today. I actually introduced that legislation in 2002. What was also done at the time was the development of a range of extra policy proposals to try to help women in crisis pregnancies. The Crisis Pregnancy Agency was established to provide free, non-judgmental help and also to undertake extensive education work. It is now part of the Health Service Executive and has undertaken its work professionally. Independent reviews show it has provided a service valued by the thousands of women who have come into contact with it.

Before addressing the specifics of the Bill, we must consider what the current legal position is and whether we need legislation. Article 40.3.3o was enacted by the people at a time when there was already a legal prohibition on abortion. It did not change the then situation. Its purpose was to ensure there could be no replication of the situation in Britain and elsewhere where a combination of the courts and the abuse of moderate legislation had allowed the effective end of all restrictions on abortion. While there are those who attack the very idea that a referendum should decide such matters and claim that Article 40.3.3o has been divisive, there is evidence that it has led to a far more honest debate. In the United States, for example, the Supreme Court justice, Ms Ruth Ginsberg, who is viewed as being very liberal and in favour of allowing abortion services, has spoken about how American society has never had a proper debate on abortion because the US Supreme Court cut it off in the Roe v. Wade decision. America has had, she believes, a longer, more divisive and negative public debate on abortion as a result.

While the constitutional text is short and direct, it does not and cannot provide the detailed guidance required in all situations. It refers to two rights and, by definition, involves significant personal and medical decisions. The 1992 X case showed this with great force. In our system and in any country which respects rights the law is as the independent courts clarify it to be. In the X case the Supreme Court explicitly addressed how the right to life of the unborn and the mother was to be vindicated. The then Chief Justice, Mr. Justice Finlay, concluded on behalf of the four to one majority that "where it is established as a matter of probability that there is a real and substantial risk to the life, as distinct from the health of the mother, which can only be avoided by the termination of her pregnancy, such termination is permissible having regard to the true interpretation of Article 40.3.3o of the Constitution." There is no doubt emerging from this finding. The law of the land has been clarified by the Supreme Court and it is and has been for 21 years that there are circumstances where the termination of a pregnancy is legal.

As it stands, there is no legal framework to regulate terminations in circumstances where there is a real and substantial risk to the life of the mother. For medical professionals and, more importantly, women, there is uncertainty. In other countries this uncertainty and the wide scope of the X judgment could have led to the opening of the floodgates which many have feared. It has not done so here. This strengthens the justification for the framework outlined in the Bill. Irrespective of how one reads the recent European judgment in the A, B and C case, I have no doubt that the facts show that legislation is required to provide a framework within which the right specified in Article 40.3.3o can be vindicated.

The late Mr. Justice McCarthy who was renowned as a jurist, motivated by his commitment to classical republicanism, made this point in concurrence with the X case judgment. He said "the failure of the Legislature to enact the appropriate legislation is no longer just unfortunate, it is inexcusable."

When I was involved in drafting the 2002 proposal, the overwhelming view of groups was that there should be legislation, with some adding the need for a constitutional amendment. Today there are many people and groups arguing that no legislation is required, that we can simply deal with this matter through medical guidelines. This is inconsistent with their past position. First, it was previously argued by many of the Bill's opponents that the X case judgment was extremely liberal and open to abuse. For example, Professor William Binchy wrote in November 2000, "as a result of the holding in X abortion is lawful." If one looks at the debates on the 2002 proposal, one finds that many people who are today arguing that guidelines are sufficient then argued the exact opposite. I acknowledge the difference between this proposal and the one made at the time, but the fact remains that until now there has been wide acceptance that some form of legislation on the circumstances of medical intervention to save the life of a mother is required.

Opinion polls should not guide our judgments on issues such as this. I take as a guide the many discussions about this issue that I have had with people in their homes and communities throughout the country during the past two months. I have found wide acceptance of the view that doing nothing is not an option. Simply leaving it to medical guidelines is not good enough. I have not met a single person who disagrees with the basic point that we must make sure everything is done in every situation to protect the life of women in pregnancy.

Regardless of whether there is explicit provision for situations involving potential suicide, there is a need for the core of the Bill. This is very similar to the approach followed in the 2002 proposal. A review framework is proposed within which it can be determined if there is a real and substantial risk to the life of the mother. It removes any potential for those involved to be prosecuted under the 1861 Offences Against the Person Act. In addition, provision is to be made for hospitals which will be covered by the legislation. The Bill is explicitly set within the context of the obligation to do everything possible to save the life of both the mother and the unborn child, even when there is a medical emergency which endangers the life of the mother. The Medical Council, the Institute of Obstetricians and Gynaecologists and the College of Psychiatrists of Ireland have welcomed the Bill. They believe it will strengthen the Medical Council guidelines which have been covering this area without the security of legislative backup and which also include the issue of suicide.

In section 9 of the Bill provision is made for situations where it is presented that a termination may be required in order to prevent the loss of the mother’s life through suicide. This is the part of the Bill which has caused the most concern and deserves to be fully examined. Those who are scared that it might be abused base their concerns on the fact that there are other jurisdictions in which provision for mental health justifications for abortion have led to complete liberalisation. This is the very reason that in 1992 and 2002 proposals were put to the people to explicitly exclude the threat of suicide as a justification for a termination. Both proposals were defeated. The 2002 proposal was comprehensive and balanced and detailed not only a revised constitutional text but also the exact legislation which would be enacted if a majority voted for the amendment.

There are those who believe there should be a further referendum to remove the risk of suicide as a ground for a termination. I do not believe this is credible; in fact, any new proposal would be defeated by a much larger majority and met with anger by a public who would rightly see it as a way of avoiding legislation. The current law, as clarified by the Supreme Court, explicitly allows for the risk of suicide as the basis for terminating a pregnancy. It does so with no statutory framework to regulate situations or prevent them from being abused. The provisions of section 9 provide for a review panel and a clear process for deciding on these cases. This is a much stronger protection against abuse than the current one where there is no requirement for a review process. I accept that there has been conflicting evidence presented on whether a threat of suicide is ever addressed by a termination, but this does not allow us to ignore the issue. The reason the Bill is reasonable on this point is that, as I have said, it actually introduces a procedure to prevent the potential that this ground could be abused to widen the availability of abortion. For 21 years the risk of suicide has been a lawful ground for the termination of a pregnancy and it has not been abused in that time. I see no evidence of any type to suggest we should now mistrust women and doctors.

The argument that the suicide ground marks the opening of the floodgates to abortion in Ireland does not stand up. The principal alternative offered by opponents to the Bill is for medical ethics, in the form of professional guidelines, to be the determining factor in regulating all situations in the protection of life in pregnancy. In effect, this is arguing that we should leave everything in the hands of medical professionals, yet at the same time we are being told that the more restrictive regulation proposed by the Bill should be opposed because it could be abused by medical professionals. Equally, it asks us to believe women will be inspired by the law to claim to be suicidal in order to have a termination in an Irish hospital. I simply cannot accept this. Fundamentally, if it is the case that the termination of a pregnancy is never justified to address a risk of suicide, the safeguards proposed by the Bill, based as they are on core medical ethics, will prevent this taking place.

Opponents of the Bill have repeatedly claimed that its provisions are similar to laws in other countries which did open the floodgates. What they fail to acknowledge is that Ireland is unique in having an explicit constitutional provision establishing the right to life of the unborn. As such, this places a direct limit on any action which can be taken as a result of legislation we pass in this House. By requiring that interventions under the Bill be "notifiable", this is not a case of legislation which will be left unsupervised. We, as legislators, and the people as a whole will be able to see if the legislation is being abused and in a position to amend it, if necessary. From what I have studied, I believe the Bill respects the Constitution and the ruling of the Supreme Court. Quite the opposite from opening the floodgates, it will actually prevent the potential that the finding in the X case could be abused.

As I have announced previously, my party will take what is for it a unique step in allowing each of its Oireachtas Members to vote in accordance with his or her conscience. My colleagues and I had a respectful debate and agreed that it would simply not be right to threaten the loss of the Whip for voting in line with one's conscience on the fundamental issue of life. The party’s position remains clearly that we are against liberalising the abortion laws. Individually, we are not in agreement on whether the Bill meets that standard. Parliaments around the world regularly allow free votes on matters of conscience. There are many good reasons we need a strong system of party discipline, but there has to be some limit to this and I believe the issue of human life is something which must not be treated like normal political business. More than any other legislation that has come before this Dáil, I have examined the Bill and the debates on it in great detail. I am convinced that it is a measure which deals with a difficult issue in a comprehensive and just manner. It does no more than provide a framework to ensure everything that can be done to save the life of a woman during pregnancy will be done. It does not change the fundamentals of the law, as it stands. As much as is possible on such a divisive issue, it adheres to the available medical advice. Vitally, it includes a mechanism to ensure the law will not be misused.

I will vote for the Bill because I believe it is true to the core objective of ensuring every necessary procedure is available to save the life of a woman during pregnancy. The legal and ethical obligation to do everything possible to save the life of the unborn remains; in fact, it will be strengthened because of the safeguards inherent in the procedures contained in the Bill.

Deputy Aodhán Ó Ríordáin

I welcome that the Legislature is finally reacting to the 20 year old Supreme Court judgment in the X case. This subject can be broken into two parts, the constitutional element and the substantive issue. In respect of the constitutional element, no other parliament in the world would be allowed to disregard a judgment of a supreme court and the decisions of the people in two referendums. It is clear that the legislation only goes as far as the Constitution permits. I implore the Minister for Health to regard this Bill as the beginning of a discussion on a new constitutional amendment which would remove Article 40.3.3° in order to enable women to protect their health during pregnancy and deal with issues of rape and incest, as well as the sensitive issue of fatal foetal abnormality. These issues cannot be addressed in the Bill before us because of the constitutional constraints under which we must operate.

It is outrageous for anybody to suggest that we should not legislate. We are required to legislate if we take our Constitution and this Republic seriously, regardless of the substantive issue at hand. We have a Supreme Court and constitutional referendums for a reason. I reject the suggestion by Deputy Martin - I listened to him but he does not appear interested in listening to me - that the previous Government should be congratulated for suggesting that a suicidal victim of rape should be forced to go through with her pregnancy. Supposedly it was a compassionate gesture to put that to the people in 2002. Thankfully, people's opinions have become much more nuanced. Those who argue that we should not legislate for the X case or the referendums of 1992 and 2002 imply that we should stage a constitutional coup. We are being asked to disregard the basis of this Republic. We cannot do that.

It has been suggested that the Bill should not be allowed to become a political football but, as a member of a party that has been on the receiving end of political kicks on this issue for the last 20 years, I find that difficult to accept. Every other political party in this House has used it to score political points against the Labour Party. It has been thrown at every Labour Party candidate and canvasser in local, European and general elections in order to distort our party's views and label us as pro-abortion. I do not even know what the term "pro-abortion" means. Our election manifestos for the past 20 years have committed to legislating for the X case. That commitment has been manipulated by others. Hushed conversations have taken place on doorsteps questioning what the Labour Party really wants to do in government and suggesting that we cannot be trusted on this issue. We have been accused of supporting abortion on demand. Thankfully, the position of my party, which has been consistent for the last 20 years, is finally in the political mainstream. People now accept the need to legislate for the judgment in the X case. That is what the people want and the Supreme Court demands.

On the substantive issue, all of us have received correspondence arguing that the Bill does not go far enough or that it goes too far. We have been intimidated and put under pressure. Our personal space has been invaded. I cannot understand why somebody would argue that a woman who is suicidal as a result of a crisis pregnancy should not have options. I do not understand the mentality of somebody who believes that a woman should be forced to go through with her pregnancy even though it means she will kill herself. As a society, we are still saying that in respect of rape, incest and fatal foetal abnormalities. If a woman's health is at risk or if she is a victim of rape or incest she has no options if she is not suicidal. Tragically, nothing in this legislation will change that. Who can honestly say it is justifiable that someone we love would be denied options if she is pregnant due to rape or incest? Representatives of a pro-life group suggested to me in my constituency office that a woman in that situation would have the option of going to England.

The central issue in this debate does not pertain to the unborn or to abortion; it pertains to abortion in Ireland. We have no difficulty with 4,000 women travelling to England every year but when it comes to upholding a woman's constitutional right to protect her life in this State through medical intervention, the national debate continues for 20 years. That is outrageous. When people from other jurisdictions are told that our debate is about situations where a woman's life is the risk, they are given to wonder whether this Republic is still in the dark ages. We have come a long way in terms of realising the debate is more nuanced than trenchant pro-life or pro-choice arguments would suggest. The debate has been used to blacken people and score political points. There was no political advantage in the stance my party has taken. We were the only party in the last general election to refer to the issue in our manifesto. However, it is a question of doing what is right rather than what is popular. When one knows something is right, one must stand up for it. Thankfully, it appears we are on the verge of legislating for this issue.

We must revisit the Constitution in order to provide for those women whose health may be threatened by pregnancy. We should ask ourselves whether such women have options and choices..

Should a woman who has been raped, or a woman who has been the victim of incest, have options? Alternatively, as a State and as a Republic should we demand in all cases that such a woman should be always forced to go through with her pregnancy? I wish cases of fatal foetal abnormalities were covered in this legislation, but unfortunately they are not. I understand that constitutional restraints mean a referendum would be possibly required. As a Republic, how can we force women in each of these circumstances to go through with their pregnancies? How can we do that and call ourselves civilised? Until we have a proper conversation about having a constitutional referendum that would potentially allow these things to take place, we will remain a Republic only in name and we will continue to rely on the UK to help our citizens. These women go to England feeling like criminals. Their health can be at risk. They may have been raped, or be victims of incest. They may be carrying pregnancies that suffer from fatal foetal abnormalities. This State makes 4,000 women a year feel like criminals. All we are providing for in this legislation is that a woman whose life is at risk will be protected and the appropriate interventions will be made. The Supreme Court said it should be so 20 years ago. The Irish people said it should be so ten years ago.

This has been a long, lonely, difficult and emotional road. It has not been a popular road to take. People in my party and others who have taken this road have had their points of view distorted, poisoned or misrepresented when they have been trying to save women's lives. Under this legislation, which I hope will be passed even though it is possibly the most restrictive abortion legislation anywhere in the civilised world, this State will continue to tell women whose health is at risk that they have to go through with their pregnancies or go to England. I suggest that from a constitutional perspective, we have no option other than to proceed in this manner. This debate has never been about whether to legislate - it has been about how we should legislate. There has been a conversation around suicide, but we have to legislate for suicidal ideation because that is what the X case was all about. The people said in 1992 that they wanted to retain this provision. I find it remarkable that Fianna Fáil has tried to congratulate itself in some perverse way on the action it supposedly took in 2002. It is bizarre to suggest to the people of Ireland that they should stand back and laud Fianna Fáil for trying to ensure a suicidal woman who wants to kill herself should be forced to go through with her pregnancy. It is monstrous to suggest that this measure was progressive, or that it progressed this argument along. All we are saying now is what the people have said twice, and what the Supreme Court said 20 years ago. The Constitution is quite clear. Anybody who does not stand by this proposal does not stand by the Constitution or by the Republic.

On the substantive issue, we should ask ourselves again whether we are really serious about forcing women to go through with pregnancies that would kill them. Are we seriously talking about forcing women to go through with pregnancies that would kill them, or do we just want them to go to England like criminals? I am almost tired of this debate. I am looking forward to the conclusion of the debate on the X case and the enactment of legislation that has been promised for so long. I hope we can then move on in a compassionate and non-party political way and start talking about a constitutional referendum that would ensure women whose health is at risk, women who are victims of rape or incest and women who are carrying foetuses with fatal abnormalities are not forced to go through with their pregnancies. Otherwise, this is not a Republic.

Deputy John Browne

I welcome the opportunity to say a few words on this Bill. Like the Ceann Comhairle, I was here in 1983, 1992 and 2002 when we had very emotive debates on all of these issues. As Deputy Ó Ríordáin has said, the debate on this occasion has been calmer and more reflective. More respect has been shown for the opinions of others than was shown in previous years. There certainly has been a change. As my party leader, Deputy Martin, has said, the Fianna Fáil Parliamentary Party had a very comprehensive and respectful discussion on this matter. Everyone's opinion was heard before we decided to give Deputies a free vote because we were unable to come to a consensual view on the Bill. The Fianna Fáil statement reiterated that "despite the different perspectives on elements of the Bill, the Parliamentary Party reaffirmed our commitment to protecting the lives of pregnant women in this country, expressed our ongoing commitment to Article 40.3.3° of Bunreacht na hÉireann and restated our determination not to seek party political advantage from this issue". I think that is the way it should be.

I fully support the case for medical intervention to save a woman's life in pregnancy. I think that is a given. Equally, every effort must be made to save the life of the unborn child. Like every other Deputy, I have been sent thousands of letters and cards on this issue and received very strong representations within my constituency. Most of them have expressed opposition to the inclusion of the element of suicide in this Bill. Some of them have expressed support for it. I believe I have fully informed myself of the concerns and issues regarding this complex and emotive issue. I watched most of the proceedings when the Joint Committee on Health and Children held hearings on this issue in January and in May. We heard much contradictory evidence during those hearings. It was very important to hear the diverse views of the medical and lay people who attended the meetings in question.

Ireland can be justly proud of its record in the field of maternal health care. It has been repeatedly recognised by the United Nations that Ireland is regarded as one of the safest places in which to give birth. That is a testimony to the great work of our doctors, nurses and the other people in our hospitals who do everything in their power to care for the mother and the child. We had a child born with spina bifida some 28 years ago. She was placed in an incubator at Crumlin hospital for many weeks because she was severely ill. We were always wondering whether she would survive. Happily, she did as a result of the wonderful care of the medical people and the nurses at Crumlin children's hospital. She went through mainstream education. Today she works, drives a car and involves herself in social activities as any normal child would do. I think every child has a right to life regardless of his or her medical condition at the time of birth. As I have said, great testimony is due to the doctors, nurses and others who work on a daily basis to ensure people who are born with disabilities are given every right to survive.

I have a major problem with the inclusion of the issue of suicide in this Bill. When I listened to the committee hearings, it was clear to me that medical experts on both sides of the debate accepted that abortion is not a cure for pregnant women with suicidal tendencies. The Taoiseach, who is entitled to his opinion, has made it clear on a number of occasions that "there is no change" in the abortion legislation as it applies in Ireland. However, I would like to quote from what a barrister, Paul Brady, said at the joint committee hearings. He stated:

It is clear that head 4 [abortion on the grounds of threatened suicide] marks a change in the law. It is not accurate to say otherwise. It creates, for the first time, a statutory basis in Irish law for what may be a direct and intentional termination of an unborn child's life.

Ms Sunniva McDonagh SC said:

What is proposed represents a significant change in medical practice. [F]or the first time in statutory provision it is being provided that the actual treatment is the termination of the pregnancy. The proposed treatment is, in fact, abortion.

Dr. John Sheehan of the Rotunda said:

If head 4 [termination on grounds of suicide] is enacted, psychiatrists will be asked to determine if there is a real and substantial risk to the life of the mother in order that she may procure a termination of pregnancy. This is a role in which Irish psychiatrists have not been involved to date. Many will not see this as their role as medical practitioners. The role could be construed as making psychiatrists the gatekeepers to abortion. Psychiatric practice relates to assessment and treatment of patients, not assessment and adjudication. Psychiatrists are not judges.

Obviously, there are very mixed views and concerns about the whole area of suicide. Many of the representations I have received in my own constituency and from across the country, from ordinary lay people and medical people, including nurses and others related to the provision of services for the mother and the unborn child, have questioned the area of suicide. Having read documentation from other countries, I believe no country or state, no matter how well-intentioned, has ever managed to restrict limited abortion legislation, especially on the grounds of suicide. For example, the Therapeutic Abortion Act in California was enacted in 1967 on strict grounds "where the mother was a danger to herself". The legislation included oversight by registered psychiatrists, yet within three years the number of abortions in the state had risen from 518 to over 63,000. Similar evidence exists from the UK, France, New Zealand and Chile, to name but a few.

I have never forced my opinion on anybody else. It is a personal opinion that I feel the suicide area should not be included and, for that reason, I have no option but to vote against the Bill. I support the majority of the areas in the Bill but the area that includes suicide will prevent me from supporting the Bill. Therefore, I will be voting differently from my leader, who outlined earlier today his reasons for voting for the Bill. As I said, it is a very emotive issue. It is an issue to which all of us have given serious consideration in recent months and, indeed, for many years. I listened to Deputy Aodhán Ó Ríordáin. I have never criticised Labour Party members for having their opinions on this issue. Every political party has its own views and concerns about this legislation going back over the past 20 or 25 years. It has not been easy to deal with. In 1992 and 2002, the public voted and there was a situation where those who were pro and those who were anti voted down those referendums.

I just want to make my personal opinions known in the House and to the people I represent. As I outlined, given the inclusion of suicide, unfortunately, I will not be able to support the Bill and I will be voting against it.

Deputy Olivia Mitchell

Despite the considerable controversy we have had around this debate, I am very happy to be a member of the 31st Dáil that will at last legislate to protect the lives of women when their life is threatened by their pregnancy. I think it is to our shame that we have waited until we were forced by the international community to take action in this area. It is to our shame that we forced sick, distressed and often heartbroken women onto boats and aeroplanes to find elsewhere the compassion that was not available to them here at home in their own country.

When I say it is to our shame, I mean it is to our shame as legislators. It is not, and has not been for a long time, the will of the Irish people that sick women should be treated like this. In successive referenda they told us what they wanted and those views have been confirmed in successive opinion polls, opinion polls which have shown the people to be far ahead of we politicians in both compassion and understanding.

I am happy, however, to now be a part of the process which will begin to leave those dark days behind us. Having said that, I know there will always be what we euphemistically call "crisis pregnancies", and I know women and young girls will continue to travel in numbers to England for terminations. I know, whatever the reason for travelling, they will be distraught, lonely and frightened.

When speaking on what I regard as a very positive development, I do not want to be carping and argumentative, but I do feel I have to say something about remarks made during the debate around accusations that this would open the floodgates and lead to abortion on demand in this country. The assumption underlying this accusation is, of course, that somehow women cannot be trusted. No girl, no woman, seeks a termination lightly. It is simply not in our nature to do so. Since time began, women across the world, across religion, across class boundaries, have loved and cherished their children, and have done so instinctively, not because anyone has legislated for it. In war and in famine, they have gone to the extremes to protect and feed their children. They have sacrificed their health and often their lives for their children. So, if women make that awful decision that they must have a termination, they do not do it lightly or without a great deal of thought, and they do it in great distress. They certainly do not do it for lifestyle reasons, as has been suggested. For me, the most distressing thing about this whole debate has been how many people think the worst of women and attribute the worst motives to them, when all of the evidence is around the selfless devotion of mothers. When women go against what is their most basic, primal instinct to protect their young, they do so for very good reasons.

While this legislation will not apply to those women who will continue to travel, I hope that the passage of the legislation and the open and, for the most part, constructive debate we have all participated in, as a society, will make that journey a little bit easier, less traumatic and less secretive for them. It is the need for secrecy, more than anything, and the absence of someone to confide in or a GP to consult, that can often make those journeys not just distressing for women but downright dangerous, both from a psychological and physical perspective.

I am sorry to say one part of the legislation also displays this lack of understanding or compassion, namely, the sanctions that apply in the Bill. I hope the Minister will reflect on the inappropriateness of the extreme penalty of 14 years in jail applying to a woman who procures an abortion, or has a self-induced one. It seems to be wholly inappropriate and Dickensian to treat a distraught woman in the same way as one would a back-street abortionist, operating for profit. Applying these sanctions, apart from being harsh, is also dangerous as the threat of such a sentence hangs over the woman and would deter her from seeking treatment should there be post-termination complications, which is not uncommon.

It is particularly dangerous in the case of use of abortifacient pills, which are now much more widely used and are freely available and advertised online. I believe these will, as time goes on, become just as common as people taking the boat to England, albeit they are really only suitable in the early weeks of pregnancy. These pills have to be used within a prescribed timescale and ideally under medical supervision, but the reality is their most likely users are young girls who perhaps cannot afford to travel and who are afraid to consult either their parents or their doctors. Adding the chill of a 14-year jail sentence to the medical and psychological trauma they are already undergoing only reinforces the need for secrecy and makes it very unlikely they will seek medical treatment, thereby possibly endangering their lives.

I suppose 14 years is slightly more humane than the legislation currently on our books, which sentences women to penal servitude for life, but it is just as chilling. I believe there is a strong possibility the 14-year sentence will not comply with the requirements of the ECHR judgment.

I welcome some changes that arose from the hearings, particularly the change of language. The original phrase in the heads of the Bill that “it shall not be an offence” has been changed to “it shall be lawful”. I welcome this because language does matter. Last weekend a former Director of Public Prosecutions suggested legal representation for the foetus should be introduced in cases of suicidal intent because the woman had “two chances to have the life of the foetus terminated.” I prefer to describe this as the woman has “two chances to save her life," which is the purpose of the legislation and a far more humane description of her dilemma and mental state. The suggestion the Attorney General should have a role in the delivery room in this case is nonsense, superfluous to what is needed to vindicate the right to life of the foetus and bizarre. The purpose of the legislation, including all of its arcane and complex procedures and requirements, is to protect and vindicate the right to life of the foetus. To do this we are compromising women's health and happily legislating to do so. If it were only the mother’s life being considered, there would be no hoops to go through, no requirement to have three specialists, no monthly reports to the Minister and no 14 year jail sentences. There would be no legislation. Were it not for the constitutional imperative to vindicate the right to life of the foetus, the only consideration would be the mother’s health, never mind her life. This is the standard medical criterion in treating any patient, except pregnant women.

It is no secret that I personally would favour allowing terminations in cases of rape, incest and particularly where there is a clear fatal foetal abnormality. I congratulate Deputy John Halligan who spoke very movingly this morning on that issue. I realise this legislation cannot accommodate that change because we must stay strictly within what is permitted under the Constitution, otherwise we jeopardise the passing of this legislation because it would definitely be challenged. It does not stop us, however, having a referendum on that specific matter and I hope that day will come.

For most people, this debate has been a long and difficult journey of conscience. The absence of a time limit on the right to a termination owing to suicidal intent has been and remains a major dilemma for many. Nobody here would be happy with the termination of an almost viable foetus and that includes all of the women and the doctors who have to make that excruciatingly painful decision. I take comfort in the fact that such a situation will arise only where there is absolutely no other treatment possible to save the mother’s life and that without that treatment, both will die, but life is not always straightforward. It is messy and full of difficult decisions. This is one area of legislation in which there are, undoubtedly, moral dilemmas, grey areas and uncertainties, but we, as legislators, have to face up to the responsibility of doing the best we can to provide a framework to ensure clarity and certainty when such very difficult decisions have to be made. It is morally unthinkable that we would let a woman die when it was possible to save her. It is equally unthinkable that, because it is easier on our consciences, we would send them to England to allow someone else to make that life-saving decision for us.

Terminations in the case of emergencies and suicide have received a lot of attention during the debate leading up to this legislation. Although such circumstances are rare, the other circumstance, under section 7, where there is a medical threat to the life of a woman which is not an emergency is of particular interest to me. First, because they are more likely to occur - we heard this morning about some circumstances where they do occur - and, second, because in many cases we are talking about sick women who desperately want to have a baby, this is sometimes overlooked in the debate. It seems incredibly cruel to force such women to take that lonely, difficult and often heart-breaking journey to England. It is my fervent wish that this legislation will end that practice forever. However I have concerns that this is not entirely clear in the legislation.

I was disturbed during the hearings that there seemed to be a lack of recognition among many doctors, particularly GPs, of the application of this legislation to those women not in need of an immediate termination. In other words, the risk to life is real and substantial but not immediate. However, it will increase as the pregnancy progresses. It is precisely to these women that this legislation primarily applies - women with severe illnesses such as cancer, high blood pressure, heart problems or kidney disease. It is vital that it is absolutely clear to the medical profession that under this legislation, it will no longer be necessary for such women to be sent to England. In other words, the threshold for a termination is a “real and substantial threat to the life”, but that threat does not have to be immediate or certain. Unless that is clear, there is a risk that women may continue to be left without treatment until it is too late and death is almost inevitable. This was clearly stated in the Supreme Court judgment and the Minister reiterated it in his contribution, but it is not clear in the legislation. However, it must be made clear by way of an amendment, the guidelines or in regulations. I ask the Minister to clarify this issue because it is vital all doctors, including GPs, are absolutely clear that this legislation caters for precisely these situations.

A related concern centres on the absence of a clear referral pathway from the GP’s surgery to an assessment process. It is normally a GP, not an obstetrician, who sees a pregnant woman first, but the legislation is silent on how the GP should act when there is a perceived threat to life. It is silent on how the referral process should take place and, crucially, the timeframe for that referral. Most people agree that if the need for an intervention is established, is it better it should happen earlier in pregnancy rather than later. This accords an extremely important role to the GP which should be clarified. I appreciate Deputy Micheál Martin's remarks that the legislation cannot deal with every specific instance, but these instances have been covered by the Supreme Court's judgment or in the Constitution. Therefore, the position must be clarified because although it has always been the law, it has not been the law as applied. If having clarity is the purpose of the legislation, it should be clearly stated in it.

Another issue of concern is the requirement for each termination to be reported to the Minister, including the registration number of the doctor carrying out the procedure. I can see how it is important to have the facts surrounding all of these cases, but I would worry about the situation, for instance, in a small rural hospital where perhaps there is only one doctor who does not claim a conscientious objection. This leaves that doctor very vulnerable and the hospital open to picketing by protesters. The last thing the staff or any woman who has already been over the hurdles required in the legislation need or needs is to have to run the gauntlet of hospital demonstrating picketers. I ask the Minister to see if there is a way the registration number of the individual doctor is not made public.

My hope for this legislation is that women’s lives will be saved by obviating the need for them to travel to obtain life-saving procedures. For those women in crisis pregnancies who will continue to travel to England, I hope this debate and the fairly reasoned argument we have had will make their journeys a little easier, less traumatic and less secretive.

Deputy Martin Heydon

I am grateful to have the opportunity to speak on this most important Bill. I am very aware of the different views it has brought up and the sensitivity of the issues involved. I fully respect the right of individuals to hold different and opposing views on the detail of the Bill and have welcomed the opportunity to speak to many constituents, colleagues and friends about the issue in recent months.

I have spent much time thinking about the issues raised by this Bill in the past six months, while deciding on how to exercise my vote. I have considered the current legal position and past referenda and the view of the medical professionals. I have also taken into account my Catholic faith and beliefs and, as a newly married man, I have considered what challenges might face my wife and me if we decide to start a family in the future.

I have tried to consider the issue from the woman's perspective - as best a man can - while thinking about those closest to me. I have challenged myself to consider what my perspective would be if my wife or sister or even a future daughter faced a risk to her life during a pregnancy. I know I would want her doctor to have the legal clarity to protect her life.

I welcome clarification on the process to be followed in the case of a risk of loss of life from a physical illness in emergency or non-emergency cases. This should provide medical practitioners with more certainty in these difficult situations.

The Bill does not introduce any new provisions into Irish law. Any change to existing law would require a decision of the people in a referendum. The Bill is no more or no less than a means of putting a structure around existing law in order to give greater clarity and certainty to medical practitioners.

A judgment of the Supreme Court, which is the highest court in the land, becomes law and cannot be overruled without a referendum decision. The Supreme Court in the X case decision interpreted Article 40.3.3o of the Constitution to determine that a termination was lawful when there was a real and substantial risk to the life, as distinct from the health, of the mother and which could only be averted by the termination of her pregnancy. Subsequently, referenda were held in 1992 and 2002 to amend the Constitution by excluding the threat of suicide from the meaning of a real and substantial risk to the mother's life and to remove suicide as a ground for abortion. In both cases these amendments were rejected by the people.

The X case ruling was applied in the C case which arose in 1998. While no termination took place in the X case as the lady miscarried, a termination was carried out in the C case as a result of the X case judgment. This shows that the X case has relevance in law today and to do nothing with this judgment has implications.

In the C case, the District Court judge ruled that an abortion was lawful if based on the report of psychiatrist. This Bill provides that such a case would require reports from two psychiatrists, one obstetrician and the woman's GP. A unanimous decision of the psychiatrists and obstetrician as to the existence of suicidal intent would be required before a termination could take place. Following the two referenda on this issue, it is necessary to respect the views of the majority of people in this country. I welcome the restatement in the Bill of the general prohibition on abortion in Ireland. I also welcome that this Bill upholds the equal right to life of the unborn and confirmation of the obligation on the medical profession to save both lives where possible. I commend the Bill to the House.

Acting Chairman (Deputy Robert Troy)

Deputy Mattie McGrath and Deputy Joan Collins are sharing time and they have ten minutes each.

Deputy Mattie McGrath

I rise today to speak against the main provisions of this Bill which, under the circumstances, must be one of the most misleadingly titled Bills that has ever come before this House. But before I do, I must express my disgust at hearing Deputy Aodhán Ó Ríordáin's contribution in which he lectured the rest of us about betraying the republic because some of us hold a different perception of what the constitutional protection of the unborn means in practice. Neither the Deputy nor his party is in any position to lecture the rest of us about distorting this debate when he himself has stated how he felt it necessary to deceive people about the intentions of the Bill in order to gain time for a more liberal regime. This statement has been recorded, whether covertly or otherwise. I have stated in the House previously that this Bill is deeply coercive and unworkable. It pays lip service to the concept of protecting women's health and the life of the unborn but despite its so-called restrictiveness it will set a precedent the consequences of which I do not believe many in this House are really aware of.

This Bill provides for the first time legislative protection for the direct intentional killing of the unborn child where the risk of suicide is deemed to be of sufficient force that it represents a real and substantial risk to the life of the mother. For all practical purposes, this Bill in its current form is shaped in every conceivable way by the ideological premises which the Labour Party has successfully bullied Fine Gael Party to accept. It is not evidence based and it ignores international clinical best practice. It effectively coerces members of the psychiatric profession into a role which they have vocally resisted since the onset of this so-called debate. How any of this helps vulnerable women and their unborn children remains confusing, to say the least.

Although the Government has claimed all along that it has no option but to legislate, this is widely contested. Legal experts have already pointed out that they know of no other area of law where a threat of suicide is sufficient to make legal what would otherwise be illegal. They further note that the notion that a simple threat of suicide would make right something that would otherwise be wrong, is a really dangerous principle. In many ways we are now in a worse situation in terms of clarity because of the inherent contradictions contained within the Bill.

Instead of leaving this issue in the hands of medical professionals who could have been tasked with drawing up more robust guidelines, we now have a Bill that seeks to reconcile the irreconcilable in terms of fusing Fine Gael and Labour policy on this issue. This is a process that has been riven with protracted political wrangling and the exposure of hidden agendas particularly on the Labour side. Indeed, the whole farce that was the health committee hearings on this Bill is something that I have been pointing out for some time. Time and again we have seen inconsistent and misleading statements being issued from the Chairman of the committee. For example, as I have already pointed out in this House, in his closing statement, the Chairman of the Joint Committee on Health and Children, explicitly stated that the Protection of Life During Pregnancy Bill as it stood, only provided a framework but not the detail. He stated it was not the final Bill, that it was a preliminary document and not the new law. The next morning, less than 12 hours later, during an interview on national radio, the Chairman explicitly stated that provision will be made in the Bill for a woman to obtain an abortion on the grounds of risk of suicide during pregnancy.

This is a deeply conflicting state of affairs and shows the Chairman had already decided to ignore the testimony of those psychiatrists and legal experts who have demonstrated such a provision is contrary to the best medical and legal practice. That was a grievous insult to the good people who came willingly before the committee. Such comments confirmed to those of us who oppose the main thrust of the Bill that this process of so-called investigation had been marked by political expediency from the outset and was never serious in its intention to objectively examine the heads of the Bill. As a member of the committee I sat there and watched in dismay as the shambolic nature of the proceedings continued day after day, week after week. What we cannot say at the end of those hearings is that there has been fair and reasonable debate. That is a great shame, not only for those of us who oppose the Bill but also for the healthy implementation of truly democratic procedures which are valued by us all.

I will deal with the main points of this proposed piece of disastrous legislation. Contrary to what the Government has repeatedly insinuated, the Oireachtas is under no constitutional duty to legislate for abortion on the grounds of threatened suicide as per the X case. There is no such thing as a constitutional duty to legislate for a Supreme Court decision and it is completely wrong to suggest otherwise. In any event, the X case judgment is not a formally binding precedent even from the perspective of the courts, never mind the Oireachtas.

The controversial aspect of the X case - the permissibility of abortion as a treatment for suicidality - was conceded without argument and therefore does not form part of a binding precedent. A basic principle of Irish law is that all points entirely overlooked or conceded without argument are not part of the precedent of a case. Contrary to what the Government has insinuated, the A, B, and C judgment by the European Court of Human Rights does not require Ireland to legislate for abortion on the grounds of threatened suicide. That decision concerned a pregnant cancer patient looking for clarity as to what treatment was lawfully available to her. The rules of the Committee of Ministers require Ireland to adopt measures that are effective for preventing the recurrence of the breach found in the particular case. Applicant C, the only successful applicant, was not suicidal. A suicide-based exemption from the statute law on abortion would not have helped her in any way. The X case heard no psychiatric evidence whatsoever - literally none. The Oireachtas is now in possession of psychiatric evidence completely unheard of by the higher courts 21 years ago. The case is being made that we have done nothing for the past 21 years. There is much more evidence available now than was available at that time. In my view, the Oireachtas is constitutionally free to take on board that evidence and craft its laws accordingly. The evidence unknown to the High and Supreme Courts 21 years ago is that abortion is not a treatment for suicidal ideation or intent. This has been accepted by all sides. This fact - widely acknowledged even by pro-choice psychiatrists - is the faulty premise upon which both the X case and the current abortion Bill rests. There is simply no psychiatric textbook or peer-reviewed study which purports that abortion is a legitimate treatment for suicidal ideation or intent.

The Bill does not provide for a time limit on the intentional abortion of a child. That is, perhaps, the single most horrifying aspect of the legislation. Despite the Minister's claims to the contrary, the Bill confers no duty on medical professionals to take into account the unborn child's welfare when deciding on an intentional abortion. It makes no provision for the care of a child delivered prematurely as a supposed treatment for suicidal intent. It provides for no legal representative to advocate on behalf of the unborn child that his or her welfare be taken into consideration.

Government spokespeople have argued that the legislation will be restrictive and that there are two high threshold tests to be satisfied before an abortion can be authorised. First, there must be a real and substantial threat to the life of the woman. Second, the risk must be one which can only be averted by an abortion. It is well established that a person is legally free to withhold consent to any and all medical treatment. If a woman refuses all treatment offered to her, it cannot be long before an abortion becomes, almost by default, the only treatment remaining that can save her life. That is the practical reality on a plain reading of the Bill. This shows precisely why mental health grounds are such an elastic legal basis for access to an abortion. Without exception, every jurisdiction which has provided for abortion on mental health grounds has experienced an unintended widening of abortion access. That is widely acknowledged. The fact that on their face Ireland's mental health grounds are narrower than those provided for in other jurisdictions is irrelevant. No matter how narrow or wide the original mental health grounds for abortion have been, every jurisdiction has experienced an unintended widening of the grounds in practice. We need only look overseas at the British Isles to see what happened and consider how the Minister who introduced the relevant legislation feels now. Without exception, every jurisdiction which has provided for abortion on mental health grounds has attempted to enshrine safeguards in its laws. Without exception, these safeguards look safer on the pages of a statute book than they do in a real life clinic.

I am aghast at the speed of the process and the bully boy tactics surrounding the Bill. The Taoiseach promised us time, but I could only be given ten minutes to speak on this fundamental, life-changing Bill. It is a Bill on the killing of the unborn and we are given ten minutes to discuss it. I am part of the Technical Group and do not complain that we had five minutes to participate in the Seanad reform debate. However, we could only be given approximately the same amount of time to speak on a life-changing Bill as on the abolition of the Seanad. It is an insult to democracy and the electorate who put all of us here to provide ten minutes in which to participate in this debate.

Deputy Peter Mathews

Hear, hear.

Deputy Mattie McGrath

The committee hearings represented a charade that will be unmasked in the fullness of time. People are not being fooled; they see what is going on. It is the tail wagging the dog. The Labour Party has got nothing else out of the Government for its supporters and the public and thinks the Bill is manna from heaven. When it had to be found out by tape, covertly, it is sad. This is only a first step towards a liberal regime and an insult to the public. What is being passed is an abhorrence.

Acting Chairman (Deputy Robert Troy)

I ask the Deputy to be fair to his colleague.

Deputy Derek Keating

On a point of order, will the Acting Chairman confirm that Deputy Mattie McGrath agreed to share his time?

Acting Chairman (Deputy Robert Troy)

Yes.

Deputy Mattie McGrath

Of course, I have.

Deputy Joan Collins

The claim by people with anti-choice, anti-abortion views and the Catholic Church that this legislation will open the floodgates to widespread abortion is a total misrepresentation. There is abortion in this country every day of the year, but it does not happen in the territory of the State. One can obtain information, access the right to travel outside the State and counselling, but the abortion does not happen here. The groups mentioned must realise that is the reality. It is a reality 83% of the population in continuous polls have recognised. It is their daughters, sisters and mothers who are the ones who deal with this issue every day of the week. It is no longer the case, as it was 30 or 40 years ago, that it cannot be talked about. A woman who was pregnant could not walk the streets as it would bring shame on her family. However, times have changed; things have moved on and there is abortion. It should be recognised that we have the same abortion rates as Croatia where it is lawful in several circumstances to save a woman's life, preserve her physical and mental health, in cases of rape or incest, owing to foetal impairment, economic or social reasons and on request. Austria which allows abortion in the same circumstances has a very low rate of 1.4%.

No one who supports this or further legislation is arguing that abortion is right in every case. For those who want to bring a child into the world, it is a beautiful occasion. It is to be cherished by the community and the State by providing the services children need, no matter what class or economic background they come from. All children should be respected equally. However, they are not.

The Government is introducing legislation to deal with what is known as the X case. We know the circumstances of the case. A young woman found herself suicidal having been prevented from travelling to Britain. What came across in the debates last year was that while there was no consensus in the psychiatric fraternity on the circumstances in which a woman could find herself suicidal and kill herself, if a woman did commit suicide on the basis of being prevented from travelling for an abortion, that would be one too many. Psychiatric nurses and doctors must stand over every decision they make in these circumstances.

In relation to suicide, under the legislation there is a requirement for two psychiatrists, an obstetrician and a referral to a general practitioner, which is onerous and the provision should be removed. Only one psychiatrist should be necessary to make a decision. The 14 year chilling legislation which has been raised with the European Court of Human Rights remains in place. It is horrendous that a young woman who finds herself in the situation which has happened every day in recent decades where she has been raped or abused and accesses the pill which can only be used in the first nine weeks of pregnancy to induce an abortion could be reported to the State and find herself in front of the courts facing 14 years in jail if she attends hospital on foot of complications. This legislation should be repealed. There should be no criminal sanction for a woman. It is a different matter in the case of back-street abortions or people acting outside the medical profession. The chilling legislation is still in place and the Government could have used the opportunity to deal with it in the Bill. Again, it has bent to the anti-choice and church lobbyists.

The referral pathway is an important issue. When a woman is referred to a hospital, who is in charge of following right through? It must be either the doctor who refers her or someone else to ensure there is a clear pathway and documentation on the care she has received for her life-threatening pregnancy in accordance with the Bill.

Provision is made in relation to hospitals and the Minister can look at the position after one year. In the bigger hospitals in Dublin one may find that more patients have been seen in relation to the issues covered in the legislation.

If there are eight women in Holles Street who had abortions in life-threatening situations, a doctor may ask whether the hospital or the doctor will be under scrutiny if he or she performs a ninth and whether the right could be taken from the hospital to provide a service to women who desperately need medical treatment.

The Bill does not deal with fatal foetal abnormality, which is a wasted opportunity by the Government. To my mind, the Bill will be challenged if passed in this form. This is an opportunity for the Government to prepare legislation which includes provisions on fatal foetal abnormality and see if the Supreme Court will defend them under the Constitution. In the European Court of Human Rights case involving Deirdre Conroy, the Government specifically said she would win her case to have an abortion in Ireland if she took the case to the Supreme Court. When facing fatal foetal abnormalities the last thing women will think of is going to the High Court or Supreme Court to seek recognition of the fact that they must travel abroad to terminate their pregnancies. A woman has a right to carry a pregnancy right to the end. It is the right of the family to support her, but it is also the right of the woman to make a choice not to carry a foetus with a fatal abnormality to full term. That service should be in place. Article 40.3.3° of the Constitution could allow for that, and we have tabled an amendment on that point. The Government should accept the amendment. If there is a court challenge in respect of the Bill, it can be examined within that context. The High Court or Supreme Court judges can examine the area having due regard to equating the right of the foetus that will die immediately after birth with the life of the mother who is being forced to carry the foetus. We will table amendments.

The Labour Party has made enormous concessions to Fine Gael and the anti-abortion lobby. Deputy Clare Daly and I introduced legislation last year and the Labour Party Deputies said they would not support it because it did not go far enough. Now, they are supporting a more restrictive Bill in respect of suicide. These are questions for the Labour Party to answer for its supporters.

We will table amendments in respect of the chilling 14-year jail sentence. I refer to people who rape women. In a recent case, two men were sentenced to ten years for the unspeakable gang rape of a young woman in Cork. A young woman who finds herself in a desperate situation could face 14 years in jail. We are introducing legislation in full knowledge of that point. We must take this point into consideration, tease it out and work through whether such a sentence should be included. It should not be. We will table amendments and we will fight for them, particularly in respect of fatal foetal abnormality. The Government has an opportunity to deal with this and should put it into legislation. If it is challenged, at least it can be challenged under Article 40.3.3° of the Constitution.

Deputy Derek Keating

I thank the Ceann Comhairle for the opportunity to speak on this Bill and I thank the Minister of State for coming into the Chamber to discuss this contentious, emotive and important issue which has troubled and held the attention of many citizens, particularly over the past number of weeks and months. The Bill seeks to implement the judgment of the European Court of Human Rights in the A, B and C v. Ireland case by way of legislation with regulations, within the parameters of Article 40.3.3° of the Constitution as interpreted by the Supreme Court in the X case, and also to make appropriate amendments to the criminal law in this area.

Like many Deputies, I have had an extraordinary amount of correspondence from all over the country and especially from my constituents in Dublin Mid-West. I respect each one of these correspondents and I have endeavoured to reply to many e-mails, postcards, letters and phone calls. I have taken the opportunity to meet people informally and I have discussed it at my party's meetings. Like others, I have had the experience of seeing outrageous posters erected outside my home and, like many other Deputies from all sides of this House, threatening telephone calls. A small number of those who made contact with me view the legislation in black and white terms but we know from experience that this is not how it is.

In December 2010, the European Court of Human Rights found that the lack of any clear mechanism in Ireland to allow a woman or her doctor to determine whether a pregnancy should be terminated when her life is at risk would be lawful in those circumstances but would be in breach of the European Convention on Human Rights. When the Taoiseach spoke about abortion in advance of the general election of 2011, he was referring to abortion on demand. Since then, this has been misused and misquoted by those who seek to mislead. Regrettably, they have influence over others. The reality is that the Government is not in favour of abortion. We have medical terminations taking place based on clinical grounds only, a point to which I will return shortly.

The Protection of Life during Pregnancy Bill does not contradict the commitment made by the Taoiseach before the last election. I trust the Taoiseach and the Tánaiste on this matter when they commit themselves to the House in saying this is not abortion on demand, as has been proclaimed by others. There is clearly a difference between medical termination of pregnancy and abortion. I want to be clear. "Medical termination of pregnancy" refers to the ending of a pregnancy for medical reasons where the mother's life is at risk, whereas abortion, for me, represents abortion on demand.

We are all charged with legislating. We are all charged with protecting life. We are all charged with the responsibility to ensure that the lives of the mother, the child and the medical practitioner providing the service are protected, but we also have a responsibility to the future in terms of how this law will be interpreted both by the courts and by this House in ten or 20 years' time. It is here that I am challenged. I have a difficulty in ensuring there is enough regulation to prevent the occurrence of what has happened in states in America and throughout the United Kingdom, particularly in England. I am personally challenged by this issue.

Throughout the hearings of the Oireachtas Joint Committee on Health and Children, many presentations highlighted the reality that the legislation governing doctors' practice was flawed and needed to be addressed. It is clear to me that this was one of the single contributing factors that influenced decision making in the care of the late Savita Halappanavar. Savita's case has been discussed by more eminent experts and I do not plan to add to the discussion, nor am I skilled enough to comment. The reality is that a woman presented to a hospital in the State and her condition deteriorated to the point at which her baby was lost and her life was at risk.

As many others have stated in this House, I do not want this ever to recur. The finding in Savita's case by the HSE investigation states that there was a "failure to offer all management options to [a patient] who was experiencing inevitable miscarriage of an early second trimester pregnancy". Section 4 of the Bill allows the Minister to make regulations on these matters. I am satisfied that the Minister, Deputy Reilly, is committed and motivated to put in place the necessary standards to ensure this legislation will not be misused or abused by practitioners or others to introduce abortion on demand, but will make options available to clinicians to address emergencies in which the life of the mother is at risk.

I am satisfied that the intention of the Minister for Health and the Government is to save the life of a woman who is in danger of dying as a result of complications, where consultants clearly indicate that if no medical intervention takes place the mother will die. As an elected public representative charged with addressing this 30-year-old problem, in all conscience I see that the motivation for this Bill is to protect the life of the mother in extreme medical circumstances. I accept that this is the only situation in which the Bill addresses legislation required as a result of the referendum on the X case.

The parish priest from Carna, County Galway, Fr. Pádraig Standún, said: "The church hierarchy has the luxury of idealism but the Government has to deliver a system where doctors and specialists are given guidance that they need in dealing with the realities of life." I welcome this intervention from Fr. Pádraig and I acknowledge the many others in religious life who have been in contact with me and who share this opinion. It is not often voiced. I challenge those who have not studied the Catholic social teaching, including the Compendium of the Social Doctrine of the Church and specifically section 570 of the Magisterium, to do so. Some will be quite surprised if they do, just as I was.

This situation requires a balanced response and that is what the Government is providing. The type of panic that has been irresponsibly generated by some factions of Irish society who want to introduce a type of theocracy or fundamentalism is not only unacceptable but has often proven to be dangerous. As I understand it, since the referendum there have been between 20 and 30 cases, on average, of termination of pregnancy every year in Ireland due to medical circumstances. What does this tell us? There has been no panic, protests, candlelit processions or street marches as a result of these medical decisions. Indeed, there have been no speeches in the Dáil from Deputy Mattie McGrath, for example.

The question of suicide as a reason for the termination of a pregnancy raises many challenging and fundamental questions for me. Having served as a director on the board of Pieta House for six years, and as a founding and pioneering worker with that organisation, I know only too well the circumstances in which a person may be suicidal. On many occasions I have seen how complicated suicide is as an issue. It requires experienced and skilled practitioners to be able to assess risk and to provide recommended treatment. Arguably, there are many more than the 600 reported cases of suicide in Ireland each year and, alarmingly, as has been mentioned in previous contributions I and other Members have made, that number is increasing. I have not seen a response from those who in recent times have protested, marched, lit candles, erected posters and sent abusive and anonymous letters in response to this Bill.

Like many other Members, I am conscious of the difficulties that face an obstetrician when confronted with the reality that a presenting mother is suicidal and is planning to end her own life, which in turn will end the life of the baby she is carrying. To be honest, I do not have the answer, and in such circumstances I must trust the professionals involved, as I trusted the professionals who took care of my own family members over the years in different circumstances when they required attention for medical conditions. Suicidal ideation is a complicated psychological condition that must be taken seriously and at all times treated with respect. I am not an expert on this but professional intervention is required when a mother presents in such circumstances.

I listened carefully to the presentations made to the Joint Committee on Health and Children, chaired by my colleague, Deputy Jerry Buttimer. It can be a fact that if doctors differ, patients can die. I do not want any patient to die and I do not want any baby to die. For that reason I trust the medical profession, the psychiatric profession and our professional health workers when dealing with each individual case as it presents in these circumstances. I am satisfied that the Minister is putting in place the necessary standards and regulations to deal with these issues, and I believe the lives of the mother and the baby will be better protected as a result of this legislation. As I have said, I am not an expert, but I trust the people who are working in our hospitals and our psychiatric units. For this reason I feel obliged to support this legislation, which seeks to protect the mother and the child in circumstances in which the life of either one, or both, is threatened.

Last October I made it clear, both publicly and at a number of meetings in my constituency - long before this issue became contentious - that I am pro-life, pro-women and pro-child. However, I am not a psychiatrist, an obstetrician or a gynaecologist. I therefore place my trust in these people, who work every day to preserve life and to ensure that the highest standards are observed. I must accept the trust we give to the Minister, Deputy James Reilly, who I am pleased to see here today, the Taoiseach and the Tánaiste.

As a legislator, I would have no difficulty voting against the Government on a matter of conscience. I have no fear of the Whip system. I do not feel confined to do what I am told. I wish to put it on the record that I am opposed to abortion on demand. I am pro-life and I stand for the rights of the mother and of the child. I believe this Bill will protect the life of the mother and the life of the unborn baby, and only in exceptional circumstances, clearly set out by the Minister for Health, should a medical termination of pregnancy take place, when the life of the mother is at risk and there is no option other than to terminate. For those reasons I support the legislation.

Deputy Timmy Dooley

I welcome the opportunity to contribute to this important debate. There has been much discussion and debate in society and within the House on this issue for many generations. However, on this occasion the debate has been conducted in a different way from the way it was conducted in the past. It is more respectful and there appears to be a better and greater tolerance of people who have an entirely different viewpoint, not just on aspects of this Bill but on matters of principle, be they pro-choice or pro-life.

I do not want to get into the label debate because there is nobody in this House who would not say he or she is pro-life. It is a question of whether Deputies believe in a more liberal approach to the termination of pregnancy or have a complete inability to countenance any actions, medical or otherwise, that would interfere with the life of the unborn. All of those positions are valid and must be respected by all concerned. I certainly respect them, and I recognise the change in the way people have decided to debate.

A small number of politicians seem to believe it was not right that they should have been lobbied on this matter. It was appropriate that people of all viewpoints lobbied their local Deputies. I received a considerable amount of information, some points of which were more novel than others, perhaps in an effort to grab my attention or change my viewpoint, but I never felt there was anything disturbing about any of it. I would vindicate the right of all to lobby, respectfully and in whatever way they wish, those whom they elect to make the laws on their behalf. That is important.

With regard to labels, it was stated this matter is an issue of conscience. It has been inferred that those who are opposing the legislation are those with a conscience and that those who support it are either without conscience or have not referred to their conscience. It is a matter of public record that I am supporting this Bill. I am doing so based on my conscientious belief that it is the right thing to do. This is in line with my duties as a legislator, cognisant of the current constitutional position. For me, the constitutional position is very clear. Article 40.3.3° was interpreted by the Supreme Court in line with that court's role as set out in the Constitution. The interpretation of the court has made it very clear that where there is a real and substantial risk to the life of the mother, the termination of pregnancy is legal. That is the law irrespective of whether one likes it. Some have argued, albeit respectfully, that the judgment is flawed. When the Supreme Court makes a finding, it is the law until such time that the electorate decides to change it.

On two occasions, the people were asked whether they wanted to remove the threat of suicide as constituting a real and substantial risk to the life of the mother. On both occasions, in 1992 and 2002, they said "No".

I wish to dispel the myth that seems to have developed during the course of this debate, namely, that nothing has been done in regard to this issue for 20 years, since the X case. An effort was made earlier by one of the Labour Party Deputies to give all the credit for action taken on this matter to the Labour Party and castigate former Governments. Over the past 20 years, previous Governments have attempted to clarify the position on the X case. In 1992, there was a constitutional referendum in which the people were asked three questions. They were asked whether a woman has the right to travel to avail of a service or facility in another jurisdiction and they said she does. They were asked whether the State has the right to provide non-directive information on abortion to citizens seeking to have a termination carried out in another jurisdiction and they said "Yes". They were asked whether they wanted to exclude the threat of suicide as a real and substantial risk to the life of the mother from the constitutional provisions set out on foot of the X case and they said "No". They said "No" again in 2002 when they were asked the question. This demonstrates an effort by successive Governments over the 20-year period to try to bring clarity to the issue. In 2002, the then Minister, Deputy Micheál Martin, introduced comprehensive legislation, much of which is part of the current Bill. It was a genuine effort by politicians of all hues at the time to bring some clarity to the issue that bedevilled society in dealing with the outcome of the X case.

The most important aspect of this legislation is that it gives clarity to the medical profession in the pursuit of its duty under Article 40.3.3° of the Constitution on the protection of the life of the mother and the unborn. There is a conflict in these very words and this is the reason for the Supreme Court issue. The legislation brings certainty to men and pregnant women, the objective being that every available intervention will be in place to protect the mother's life.

There should not be a hierarchy of mother and child. That is set out in Article 40.3.3° but it is a fact that if the mother does not survive, the child certainly will not either, unless it is in the late stages of gestation. While it is nice for some to live in an obscure world in which they do not have to deal with issues such as this daily, the reality is that, from the perspective of a medical professional or pregnant woman, the truth is different. I listened with interest to the submissions to the Joint Committee on Health and Children. I understand that between 25 and 30 terminations of pregnancy take place annually for medical purposes. Some seek to make this a grey area and suggest it is an unintended consequence, and that the terminations do not constitute an abortion as defined wherever they derive their definition. In many cases, it is a direct intervention and not the side-effect of some tablets that are taken or an injection given. It is the direct and intentional disruption of a pregnancy to save the mother's life. That is acceptable and legal and this is clarified in this Bill. For me, all the Bill does is set out how the decision is made. It puts in place a proper procedure for taking the decision to end a pregnancy to save the mother. This seems to be medically acceptable to many.

The main issue in this legislation that has divided us in this House and perhaps outside it concerns suicide. In the debate on suicide in this House and outside it, it is stated nobody really understands suicide and can get inside the head of a person who has committed suicide. This is why the matter has bedevilled legislators and medical professionals for so long. It has prevented the capacity to intervene at an early stage to prevent the loss of life through suicide; yet, in the debate on the termination of pregnancy for a woman at risk of losing her life by suicide, some in this House and many outsiders seem to have all the answers. We have heard the phrase, "Abortion is not a cure for suicide." It is a meaningless statement but it has common currency. It is used as a standard defence in arguing why we should not consider the threat of suicide and why we should not clarify, for the woman in question and medical professionals, the methodology for establishing whether there is a real and substantial risk to the life of the mother through suicide. Some say there is no test, and there is none. I was taken by the Minister's medical adviser, Tony Holohan, who said understanding or determining whether a pregnant woman is suicidal does not involve a hocus-pocus method.

Some of the commentary that has sought to cast aside the threat of suicide as a real and substantial risk has been damaging to the general debate on suicide. It is hurtful to those who have gone through an episode of suicidal tendencies and to the families of those who have died by suicide. On the one hand, people say that does not constitute a real and substantial risk but we all know families left in the wake of a death by suicide and that is disturbing. If we want to distil this further, is it the case that some people are saying they do not trust Irish women and that they will somehow present themselves as suicidal before three doctors in an effort to procure a termination? That would be illegal under this legislation because it would mean attempting to use it for a purpose for which it was not established. People are unfairly casting judgments about the suicide issue. The fallout from the debate will be the impact it has on the families of men and women who have lost their lives through suicide and I hope once the passage of the Bill has been dealt with, the Minister will take a strong leading role in attempting to put in place a framework in which the issue of suicide would be addressed more comprehensively by the State and its agencies.

It is also the case that the Medical Council guidelines recognise that abortion is legal in Ireland as set out in the X case but some have sought as a reason we should not have legislation to offer a number of alternatives, including another referendum. I have set out my views on that clearly. I do not think, based on the opinion polls and research I have seen, that if we were to ask the people again whether suicide should be removed from the Constitution as a ground for abortion, there would be a different result. It would go much more the other way. There are some who oppose this legislation who say the wrong question was asked in 2002 because there were ethical and moral issues around when life began under that legislation and whether it was at conception or implantation. Some suggest that if we went back to conception that would address their concerns and they would be able to vote in favour of such a referendum but that would exclude a much larger cohort of people for whom the morning-after pill is an acceptable course of treatment. There is no alternative but to legislate and that is why I support the legislation.

I would like to dispel the myth that the State does not have to legislate as a result of the A, B, C v. Ireland case and that it could somehow do what needs to be done through guidelines. The Medical Council has been offered as the means by which that would happen. However, it is difficult to get on record the facts as they pertain to the council's guidelines. Many people on the extreme side of the pro-life movement put their faith in the Medical Council guidelines, but paragraph 21.1 states:

Abortion is illegal in Ireland except where there is a real and substantial risk to the life ... of the mother. ... [T]his exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide.

That is simple and it sets out the framework under which a termination can take place currently. This guideline for medical practitioners further states: "You should undertake a full assessment of any such risk in light of the clinical research on this issue". That is the only principle that guides a physician in the termination of a pregnancy arising from the threat of suicide. As previous speakers said, Professor William Binchy recognised this in 2000 when he said that the decision of the Supreme Court effectively made abortion legal in Ireland and the regime could be wide open and liberal.

My support for this legislation is based principally and wholly on a pro-life stance. Like others, I do not believe we should have liberal abortion laws in this country, but we have to be consistent with the Constitution and we have to limit the potential for a more liberal abortion regime, which is possible depending on the way the Supreme Court decision is interpreted within the provisions of the Medical Council guidelines. It is clear there are virtually no restrictions on the capacity of clinicians, from whatever angle they might be coming, to terminate a pregnancy. We think it does not happen, but there is no reporting system in place similar to that which will be introduced under this legislation. All the legislation does, therefore, is to codify and clarify the overarching provision in the Constitution. It tries to set out a system by which decisions are taken in order that they are traceable and to ensure consistency among clinicians and pregnant women. We need to pass this legislation without delay for that reason.

I am pro-life, and abortion will not necessarily solve problems. It may seem like the obvious way out during the immediate shock, confusion or crisis a women goes through when discovering she is pregnant and does not want to be. Those of us who have met women who have had abortions and were deeply hurt as a result know it is not the solution. Other women take that decision and they are fine with it afterwards. That is a fact of life, which must be recognised as well. However, the gaping hole in our approach to abortion in this State is that 5,000 women still travel silently to the UK on an annual basis and they will continue to do so following the passage of this Bill.

I am disheartened by the attention focused on us, as legislators, by some who seek to protect the unborn. They have every right to do that but when this debate concludes, will attention turn to trying to assist those women for whom there does not seem to be an obvious way out? It is sad that both the political system and civil society do not make a greater effort to prevent these abortions, many of which could be prevented if there was an appropriate level of support and non-directive counselling and a genuine belief among women facing a crisis that there was somebody they could to go to seek assistance and guidance. For some, the pregnancy is a crisis. They cannot talk to their families or friends and they feel excluded and isolated. I have no doubt that, were it not for the fact that there is access to a liberal abortion regime in England, there would be a greater number of deaths through suicide among pregnant women in this State.

I appeal to the Minister on the passage of the Bill to undertake a comprehensive review of the issue of women who travel to have an abortion to ensure that for those who have made a conscious decision they believe is right, it is respected and accepted. Assistance must be given to those who are not thinking clearly, who are not in a good place and who are not in a position to make a rational decision because of the crisis in which they find themselves. They become deeply hurt and traumatised as a result of the decision they took and they come to us at a later stage.

I support the Bill, which is right and appropriate. I do so believing it is consistent with my pro-life stance. I respect the right of others to have a different opinion but I ask them to set out clearly their solution to the X case judgment and to recognise the decision the people have taken on two occasions.

Debate adjourned.

Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.

Dáil Éireann debate - Wednesday, 26 Jun 2013

Protection of Life During Pregnancy Bill 2013: Second Stage (Resumed)

Dáil Éireann debate -
Wednesday, 26 Jun 2013